Transforming kidney health and the burden of CKD

At AstraZeneca, we believe we have an important role to play in driving better patient outcomes. We are aiming to help reduce progression to kidney failure by 20% by 2025. Through global collaborative initiatives, informed by our real-world evidence (RWE) programme, our ambition is to support healthcare professionals (HCPs) in prioritising CKD diagnosis and management, ensuring patients understand their risk factors and can address these with their HCPs, and to work with stakeholders in prioritising CKD screening at the policy level.

CKD: a silent disease with devastating consequences for patients

It’s staggering to see that although CKD is expected to become the world’s fifth leading cause of mortality by 2040⁴, up to 90% of people living with CKD don’t know they have it.³

Patients with CKD experience decreased kidney function and if untreated, their CKD could eventually progress to life-threatening kidney failure⁵ although most patients are more likely to die from cardiovascular causes before getting to this stage.⁶ Many of these patients will need renal replacement therapy such as dialysis to replace their kidney function⁷, which significantly affects their quality of life.⁸

Even before progression, people living with CKD report that their lives and daily activities are impacted by the disease and its complications.⁹ They can experience significant physical limitations, loss of quality of life, unemployment, emotional and cognitive disorders, social isolation and premature death.¹⁰ If a patient’s CKD advances to where they need dialysis, they may experience additional stress from the financial impact and time commitment of dialysis, while feeling like a burden to caregivers.¹¹

CKD does not just impact patients at the individual level, but also society and the environment more broadly. CKD is a leading cause of health expenditure worldwide,¹² and its burden weighs heavily on individuals and healthcare systems alike. In high-income countries across the world, 2–3% of the annual healthcare budget is spent on renal replacement therapy.¹³

Additionally, treatments for CKD, like dialysis, leave a considerable carbon footprint and can cause environmental pollution due to frequent medical interventions, the use of products that generate medical waste, energy to run machines and water consumption.¹⁰ Dialysis remains one of the most carbon-intensive fields in medicine, consuming enormous amounts of water and producing high amounts of medical waste.¹⁴ In a year, globally dialysis uses more than 169 billion litres of water¹⁰ and creates more than one billion kg of medical waste.¹⁵

As the burden of CKD continues to grow, the environmental impact is expected to do so too: recent UK data predicts environmental impacts equivalent to 1.35 million tonnes of CO₂ emissions for patients receiving in-centre haemodialysis by 2032 – and the total environmental impact would likely be larger if all CKD care pathways were included.¹⁶

Who is at risk for CKD?

CKD can affect anyone, but a person is at an increased risk if they have diabetes, high blood pressure, heart disease, obesity, or a family history of chronic kidney disease.¹⁷

CKD is known as a silent disease in its early stages, since it is normal for patients to experience few, if any, symptoms early on.¹⁸ This means it is often diagnosed late and left untreated for too long.¹⁸ Typically, people with CKD could lose up to 90% of their kidney function before experiencing any symptoms of the disease.¹⁹ Lost kidney function cannot be recovered, leaving healthcare providers (HCPs) and patients with the prospect of kidney failure.²⁰

Early CKD diagnosis may slow progression and avoid cardiovascular complications²¹

Recent RWE of United States health data has demonstrated the benefits of recording a diagnosis at Stage 3 CKD, showing it can help to improve kidney health with a significant decrease in estimated glomerular filtration rate (eGFR) decline. Delaying the diagnosis of Stage 3 by one year resulted in an increased disease progression to Stage 4 or 5 by 40% and the risk of needing a kidney transplant or long-term dialysis treatment by 63%, which are indicators of kidney failure. This highlights the need for earlier screening in at-risk populations.²²

While CKD can be difficult to treat on its own, it can also increase the risk of cardiovascular (CV) diseases and death.^23,24 Research continues to show the connection between cardiovascular and renal conditions, and since the heart and kidneys are so closely related, CKD can cause or worsen CV conditions such as heart failure.^23,24 Up to one in five patients diagnosed with CKD develop HF, making it the leading CV complication in CKD patients.^23,24

Our commitment to people living with CKD

We consider ourselves a central part of the healthcare community and are committed to working with the entire kidney community – patients, HCPs, policymakers, industry leaders and more – to transform CKD delivery and care.

By 2025, our ambition is to support the screening of 140 million people at risk, and to help transform kidney health and reduce the number of patients developing kidney failure by 20% through partnerships with key healthcare stakeholders and policymakers.

To realise this ambition, we launched the Accelerate Change Together (ACT) on CKD programme to drive comprehensive CKD change across the healthcare ecosystem. Through ACT on CKD, we aim to increase awareness of CKD, support primary care physicians to carry out routine screenings and diagnose CKD early, highlight the need for policy reform to achieve sustainable change to support people at risk of CKD, and ultimately reduce the risk of disease progression.

Early screening and diagnosis are particularly vital components of ACT on CKD, as early identification and intervention can help improve outcomes and quality of life for CKD patients. Since the launch of ACT on CKD in 2021, we estimate that we have contributed to the screening of over 32 million at-risk people and helped over 10 million CKD patients be diagnosed globally.

Projects to encourage urgency of screening and diagnosing CKD early

To drive change in CKD, we are working together with global, regional and local partners. We support many projects around the world to help health care professionals facilitate the screening of at-risk patients for CKD by increasing blood (eGFR) and urine (urine albumin-creatinine ratio) testing in the out-patient settings, such as doctor’s offices or outpatient clinic waiting rooms. In some countries we also support home screening with easy-to-use urine test kits.

A growing body of evidence to drive understanding of CKD

We want to provide healthcare providers (HCPs), decision makers and patients with the necessary information to drive change. We are committed to expanding understanding around CKD and have generated real-world evidence on:

CKD requires immediate collaborative action

It will take the entire kidney community – patients, HCPs, policymakers, industry members and more – to transform CKD delivery and care to shift from kidney failure to kidney preservation. We remain steadfast in our commitment to transforming CKD and won’t rest until we have achieved sustainable change for patients all over the world.

Veeva ID: Z4-58891
Date of preparation: October 2023